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Senin, 07 April 2014

United Healthcare and I. DuPont Hospital Fail To Reach An Agreement on Contract- This Time It’s the 33,000 Kids That Have To Find New Doctors and Hospitals Or Change to An Aetna Medicaid Plan

First it was Medicare Advantage doctors and now it’s the kids as contract renewal seems to have failed for this children’s hospital in Delaware. The news article states the two sides are still talking but not every day so you can figure out what means. To stay in network the next closest facility is almost 20 miles, not too bad for a summer drive but pack in some snow in the winter and that could be along drive especially in the case of an emergency. BD

If you lived on the northbound I-95 ramp from Naamans Road in Claymont – one of the state's northernmost locations – you'd drive 19.9 miles or 24 minutes (in clear traffic) to reach Children's Hospital of Philadelphia, according to Google maps. Baltimore's pediatric hospitals are more than 60 miles from any spot on the Delaware-Maryland line.

The contract expiration and Nemours' removal from United's network both came after most enrollment periods had expired – for employer-provided plans and for the government's insurance marketplace plans, which had a March 31 deadline.

The contract between the hospital and the insurer expired Monday, leaving thousands of kids to find new doctors and treatment facilities.

State officials found a speedy solution for the 33,000 Delaware kids whose medical coverage came through UnitedHealthcare's Medicaid plans, contracted by the state. Those kids were allowed to switch to the Medicaid plan offered by Aetna-owned Delaware Physicians Care Inc. and have until April 25 to do so.

Medicaid plans have other constraints, too. In 2012, new terms required Medicaid insurers to provide access to a primary care physician within 20 miles or 30 minutes' drive from the insured person's home.

If their children have been treated at A.I., they must either find new doctors and facilities within United's network – the nearest pediatric hospitals are in Philadelphia or Baltimore – pay out-of-network prices or get special provisions to stay at A.I. for treatment they can't get elsewhere.

In that case, Florida officials say they got word from United in January that Nemours had terminated its physicians group's participation in UnitedHealthcare's Medicaid and Florida Healthy Kids plans. Notice of that change went out to 1,887 Medicaid recipients and 1,974 Florida Healthy Kids (low-cost, non-Medicaid insurance) recipients, according to Shelisha Coleman, spokeswoman for the Florida Agency for Health Care Administration.

"But it's worth noting that A.I. DuPont has been able to reach terms with all the other insurers out there, including managed care" said Wayne Smith, president and CEO of the Delaware Healthcare Association, which represents medical facilities throughout the state. "Clearly there are terms available that are satisfactory to the hospital and the insurance industry.